Fall in funding raises question mark over future of global fight against Aids

Orphans at the Mildmay HIV Centre in Kampala, Uganda. A funding drop has raised concern about the long-term future of the global fight against Aids and HIV. Photograph: Jon Hrusa/Pool/Reuters

International funding for Aids programmes in developing countries across the world dropped by 10% in 2010, according to a new report, raising concern that funding for the global fight against HIV and Aids may be on a long-term downward trend.

Figures show that funding from 15 of the world's largest donors dropped in 2010 for the first time in a decade. An annual funding analysis by UNAids and the Kaiser Family Foundation, released this week, shows donors gave $6.9bn in 2010 for HIV prevention, care, treatment and support – down $740m from 2009.

The decrease comes when innovative methods to stop the spread of HIV are emerging. Earlier this year, for example, groundbreaking studies in Botswana, Kenya, and Uganda, found that partners of people living with HIV can protect themselves from infection by taking a once-daily pill. At the UN high-level meeting on Aids in June, donors committed to put another 9 million people on treatment by 2015, raising the total number of those receiving HIV treatment to 15 million.

But mobilising the resources needed to take advantage of new treatments, and raising funds to meet the "15 by 15" goal, now looks more challenging than at any time in the past 10 years.

This week's study shows funding for HIV and Aids programmes in low- and middle-income countries increased more than six-fold between 2002 and 2008, before levelling off in 2009 and dropping in 2010. Much of this change is attributed to the impact of the global financial crisis on government budgets.

Of the 15 donors surveyed by the report, seven had rolled back their funding for HIV and Aids programmes in 2010. Some of the overall drop is due to fluctuations in countries' exchange rates. But the fall is largely driven by a reduction in disbursements from the US: "as the single largest donor, the US delay affected the overall financial picture for the year," said the report.

While Washington appropriated about $5.5bn for Aids in both 2009 and 2010, disbursements dropped from $4.4bn in 2009 to $3.7bn in 2010. Figures are not yet available for 2011.

Despite the drop in funding, Bernhard Schwartlander, director of evidence, strategy and results for UNAids, insists: "We haven't seen a decrease in access to services. More people have received treatment than ever before."

"Even though we have seen – for the first time – a significant decrease in funding from international donors, we have also seen programmes become more efficient," explains Schwartlander. "But could we have done more if we had more resources? That, of course, is a very different question."

A key issue is whether the decrease in funding in 2010 is a one-off drop or the beginning of a new trend. If donor contributions to the fight against HIV and Aids continue to shrink, "it will be impossible to get where we need to go," says Schwartlander.

"The drop in funding may be a temporary blip," says Jennifer Kates, vice president and director of global health policy and HIV for the Kaiser Family Foundation. "However, given the budget battles in Washington – and the fact that the US provides the majority of donor government funding for the Aids response – the future of Aids financing remains unclear."

UNAids estimates that at least $22bn will be needed by 2015 to reach the millennium development goal targets to ensure universal access to HIV prevention, treatment, care and support. This level of funding could prevent more than 12 million new HIV infections and avert more than 7 million deaths, says this week's study.

At June's UN meeting, commitments were reaffirmed to raise funding for the global Aids response to $22-24bn by 2015.

Some key points from this week's report:

• Of the 15 governments surveyed for the study, donations from seven – Australia, Germany, the Netherlands, Norway, Spain, Sweden and the US – dropped in 2010.

• While $8.7bn was committed towards the global fight against HIV and Aids in 2010, only $6.9bn was actually disbursed.

• In 2010, despite the slowdown in disbursements from Washington, the US was still the largest donor, accounting for more than half (54.2%) of Aids funding.

• But, taking into account the different sizes of government economies, the US ranks seventh in Aids funding as a share of GDP. Denmark ranks first, followed by the Netherlands, Ireland, the United Kingdom, Sweden and Norway.

• Overall, funding increased more than sixfold between 2002 and 2008, before levelling off in 2009 and dropping in 2010. The biggest year-on-year jump in funding was between 2007 and 2008, when flows rose from $4.9bn to $7.7bn.

Note that the data in the report focuses on funding for the delivery of HIV-related services – from prevention and care to treatment and support – and doesn't include funding for international HIV research carried out in donor countries.

And just because overall funding has dropped doesn't mean that all Aids programs have suffered a shrink in resources. Different programmes may attract different levels of funding. In November, UNAids is expected to release a more detailed analysis of financing for the global Aids response, looking in part at the support received by different types of programmes.

Here we're highlighting the data from this week's report. We've also looked at previous funding analyses, extracting figures on countries' past commitments and disbursements. What can you do with the data?